What is the role of antivenom in the management of scorpion envenomation?

Updated: Nov 09, 2018
  • Author: David Cheng, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Antivenom is the treatment of choice after stabilization and supportive care. Because of the heterogeneity of venom composition between different scorpion species, one species' antivenom will have limited effect on another scorpion species' venom. Thus, correct scorpion species identification is a prerequisite for proper antivenom treatment.

For newer scorpion antivenom, the exact dosing has not been established as animal studies treatment amount does not translate into human studies treatment amount. In addition, the quantity to be used is determined by the patient’s clinical severity, symptom evolution, and treatment response. Unfortunately, predicting the patient’s response treatment is difficult, which makes exact antivenom dosing difficult. Furthermore, underdosing will result in limited or no effect, while overdosing increases the side effects and hypersensitivity reactions. Because the new antivenoms are highly purified immunoglobulin fragments, adverse reaction is less frequent and tends to be mild.

The antivenom significantly decreases the level of circulating unbound venom within a few hours. The persistence of symptoms after the administration of antivenom is due to the inability of the antivenom to neutralize scorpion toxins already bound to their target receptors. Thus, symptomatic and supportive treatment is needed with immunotherapy. [35]


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